Assessing Use of mHealth Applications Since 2022: A Systematic Review
by Lieneck C1*, Carr E2, Voss M3, Smith D3, Townsend D3, Washington C3, Wallace A3
1School of Health Administration, Texas State University, San Marcos, TX 78666, USA
2McCoy College of Business, Texas State University, San Marcos, TX 78666, USA
3School of Health Sciences, Southern Illinois University-Carbondale, Carbondale, IL 62901, USA
*Corresponding author: Lieneck C, School of Health Administration, Texas State University, San Marcos, TX 78666, USA.
Received Date: 12 June, 2024
Accepted Date: 19 June, 2024
Published Date: 24 June, 2024
Citation: Lieneck C, Carr E, Voss M, Smith D, Townsend D, et al. (2024) Assessing Use of mHealth Applications Since 2022: A Systematic Review. Rep GlobHealth Res 7: 203. https://doi.org/10.29011/2690-9480.100203.
Abstract
The surge in the utilization of mobile health (mHealth) apps for monitoring and improving physical fitness continues to occur beyond levels initially experienced during the COVID-19 global pandemic. This systematic review aims to assess the various mobile health apps available for tracking and enhancing physical fitness levels between January 1, 2022 through June 2023. A comprehensive search of electronic databases was conducted to identify relevant studies published to identify most recent trends in the mHealth industry sector. The inclusion criteria involved mHealth apps designed for assessing and promoting physical fitness among individuals. The review analyzed app features, usability, effectiveness, integration of fitness tracking technologies, and overall impact on physical fitness. Additionally, the review considered user satisfaction, adherence, and any barriers encountered in using these apps. The synthesis of the findings will provide valuable insights into the effectiveness and appropriateness of mHealth apps as tools for promoting physical fitness during the COVID-19 global pandemic and beyond, aiding in the development of informed strategies to optimize the use of technology for enhancing public health and well-being.
Keywords: Mobile Health Applications; mHealth; Physical Fitness;Exercise.
Introduction
Background
The rapid proliferation of mobile technology has revolutionized various sectors, including healthcare, where mobile health (mHealth) applications have emerged as potent tools to bridge gaps in healthcare access, monitoring, and delivery. mHealth, defined as the practice of medicine and public health supported by mobile devices, offers opportunities to enhance patientclinician communication, improve health outcomes, and reduce healthcare costs. These applications range from simple medication reminders to sophisticated remote patient monitoring systems, showing potential to transform the patient experience and redefine healthcare in the digital age.
The global mHealth market has seen exponential growth, driven by increasing smartphone penetration, high speed data connectivity, and a rising inclination towards personalized healthcare. Patients and healthcare professionals alike have recognized the benefits of real time health monitoring, disease management, and preventive care that mHealth applications offer. However, as the adoption rate continues to climb, it becomes imperative to critically assess the efficacy, security, and overall impact of these applications on patient outcomes and the broader healthcare ecosystem.
While there are numerous anecdotes and qualitative reviews praising the advantages of mHealth, rigorous empirical research remains limited. This study aims to investigate the effectiveness of mHealth applications, scrutinize their strengths and weaknesses, and understand the broader implications of their integration into contemporary healthcare. Through a multifaceted approach, this research will provide insights into the real world applications, challenges, and the future trajectory of mHealth in the global healthcare landscape.
Purpose
As the world emerges from the shadow of the pandemic, mHealth apps have gained unprecedented traction in promoting physical fitness amidst lockdowns and restricted outdoor activities. Investigating the use of these apps is crucial for understanding the facilitators and barriers influencing individuals’ physical fitness levels during such challenging times. An in-depth analysis can reveal how features, user interface, or even social integration within these apps enhance or impede regular physical activity. Furthermore, understanding these dynamics can provide insights into designing better digital interventions, ensuring that populations remain active and healthy even in the face of future crises or restrictions. This knowledge is not only pertinent for individual well being but also has broader societal implications, considering the links between physical fitness, overall health, and healthcare expenditures.
Materials and Methods
Overview and Inclusion Criteria
This systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The research team’s overall intent was to investigate published literature surrounding the use of mhealth apps in recent literature/ publications, building upon prior mHealth reviews and industry observations (therefore, 2022 to-date research articles). Literature for this review was obtained from three separate databases: Academic Search Complete, Business Source Ultimate, via Ebson B. Stephens Company (EBSCO host) and PubMed (which queries MEDLINE) at Southern Illinois University-Carbondale. These databases were utilized to ensure a broad search of the research topic, as initial investigations demonstrated limited publications in other research databases.
Focusing specifically on ‘mhealth’ and related publications, the Medical Subject Headings (MeSH) controlled vocabulary thesaurus (National Library of Medicine) was utilized to capture exploding terms for this topic, as well as ‘physical fitness’ and related terminology. Additional research team queries on the EBSCO host website were conducted to ensure the highest number of published articles germane to the research topic were identified using the most amiable Boolean search operators to identify the following search string for the study:
[(mobile health applications”) OR (“mhealth”) OR (“mobile apps” )] AND [(“physical activity”) OR (“exercise”) OR (“fitness”) OR (“physical exercise”)]
Articles included in the review had to be published between 1 January 2022 through 2024 on the research databases, with the actual database queries occurring between May 1 – June 10, 2023 by the research team. The 2024 ending search date range was auto populated by the EBSCO host website, therefore delineating the most up-to-date publications during the review team’s search period (note: often, the next year’s pre-populated to also capture articles published with future journal dates, etc). Full-text only, English-only were required search parameters on the EBSCO host platform, and editorials, government re-ports, letters to editors, or other non-peer reviewed studies were not included in the review. The research team was able to access and/or locate all the article citations identified in the search in full-text format to permit follow-on literature review.
Studies in the review had to focus on or address the use of mhealth applications, either as the primary research topic, or at least be included as part of the research process or observations in the studies. The research team conducted a search for the most recent, relevant literature to simply assess the use of such technology to identify underlying themes (constructs) in the literature regarding mhealth apps during a declining pandemic phenomenon. The study’s information did not include human subjects (secondary data sources), with all of the literature published and publicly available. If studies identified by the research team focused on any individual research subject(s), they were unidentifiable. As a result, this systematic review qualifies under the “exempt” status in 45 Code of Federal Regulations (CFR) 46. Further, an institutional review board (IRB) was not required and no consent was necessary.
Exclusion Process
Figure 1 demonstrates the article exclusion process for the review, starting with the initial research database results and ending with a final literature sample (n = 25). Initially, 13,525 articles were identified as meeting the primary search criteria – addressing both mhealth and physical fitness review criteria. Because three research databases were used in the review, a high number of duplicate articles were observed in the initial search (5,623 total duplicates). The EBSCO host search engine options were then used to only include full-text, English-only, peer reviewed articles in the review, published within the 1 January 2022 through 2024 timeframe. This further reduced the number of articles included in the initial database search. The research team conducted an abstract screening process (abstracts located on the EBSCO host website for each article) of the remaining 702 articles in the search, further excluding articles that did not include both mhealth and physical fitness-related research topics (-664 additional articles).
Figure 1: Preferred reporting items for systematic reviews and meta-analysis (PRISMA) figure that demonstrates the study selection process.
The research team sought 38 articles for retrieval in full-text format for official full-text review per PRISMA guidelines, with each identified publication being reviewed by at least two members of the research team. Table 1 shows the delineation of review articles assigned to the research team members.
Article |
Reviewer 1 |
Reviewer 2 |
Reviewer 3 |
Reviewer 4 |
Reviewer 5 |
Reviewer 6 |
Reviewer 7 |
Assignment |
|||||||
Articles 1–8 |
X |
X |
X |
X |
X |
X |
X |
Articles 9–16 |
X |
X |
X |
X |
|||
Articles 17–25 |
X |
X |
X |
Table 1: Reviewer assignment of the initial database search findings (full article review).
The research team’s full text review for eligibility resulted in 38 remaining publications remaining in the review. 13 articles were removed from the review by the research team as follows:
- 11 articles were deemed not germane to the research topic. Either erroneously added by the initial database search, or somehow mentioning “mhealth,” yet not related to “physical fitness” (or related exploded MeSH terminology for both topics.
- Two articles were removed as additional duplicates.
The research team collaborated online via webinars to address any potential article bias or conflict with the application of the selection criteria for the review. Several consensus meetings resulted in no disagreement among the research team members in this regard.
Results
Study Characteristics
The team’s full-text review of the 25 articles identified underlying constructs (characteristics) associated with surprise billing (perceptions and/or challenges) within the US healthcare system. A summary of review findings for each article is provided in a modi-fied PICOS table (patient, intervention, control, and outcome) to fit the purpose of this review (Table 2).
Article Number and Title |
Population |
Intervention |
Outcome |
[Use/purpose of mHealth
application] |
[Physical fitness
assessment/observation] |
||
[1] SMART STEP – SMARTphone-driven exercise and
pedometer-based STEP intervention to promote physical activity among
desk-based employees: Study protocol for a three-arm cluster randomized
controlled trial |
Desk-based employees aged between 30 and 50 years
from various administrative offices of a multifaceted university in India.
Total participants: 159. |
·
The main
purpose of the article is to investigate how physical activity, technology
based, or education based, affects the performance, productivity, and
cardiometabolic risk associated with employees that are desk-based.
·
The method
used in this study was the three-arm cluster randomized trial. The subjects
in the study will be conducted with various employees from the age of 30-50
in different administrative offices. |
·
The study was
separated into two groups. The SMART group and the TRADE and CONTROL group.
The SMART group showed significantly better outcomes than the TRADE and
CONTROL group. These results will aid in developing recommendations as to how
to improve the physical activity of these desk-based employees. ·
Accelerometer-measured
sitting time and PA levels. |
[2] Adapted exercises versus general exercise recommendations on chronic
low back pain in industrial workers: A randomized control pilot study |
Assembly line workers with chronic low back pain
(LBP). |
·
Adapted
exercises tailored to the characteristics of the workplace plus general
exercise recommendations. The exercise program is delivered through a mobile
application (APP). ·
The main purpose
of this article is to determine if an exercise program that is formed in the
workplace can supplement general exercise recommendations given to employees,
specifically industrial workers, with lower back pain. |
·
Industrial
workers were randomly assigned to both group adapted exercises as well as
general exercise recommendations and control groups exercise recommendations
to determine the most effective method. ·
This study
concluded that an adapted exercise program plus the general recommendations
for industrial workers suffering from lower back pain could be an effective
treatment. |
[3] Promoting Optimal Sexual and Reproductive Health with Mobile Health
Tools for Black Women: Combining Technology, Culture and Context |
Black women in the U.S. with disparities in
sexual and reproductive health outcomes. |
·
Use of mobile
health (mHealth) tools. Comparison:
without the use of mHealth tools or traditional health communication methods. ·
The main
purpose of this article is to use mobile technology and mobile health
interventions to provide sexual education and to sustain the outcome to
specific populations. ·
The method
used to gather data for this study was to use a multimedia platform that
encourages user engagement. An example of this provided is the app “Girl
Talk”. This app allows users to be specific to their individual and cultural
needs. |
·
Reduction in
disparities of sexual and reproductive health outcomes. ·
This study
was proven to be successful in improving the reproductive health outcomes as
well as alleviate health disparities among this specific population. |
[4] Effects
of vehicular whole-body vibration on focus measured by a mobile app for brain
training: A pilot study on the influence of gender and Attention Deficit
Hyperactivity Disorder |
Students and other professional drivers, both
genders, with and without Attention Deficit Hyperactivity Disorder (ADHD). |
·
Exposure to
whole-body vibration (WBV) while travelling on a stone paved route.
Control: Not exposed to WBV during the
journey. ·
The main
purpose of this article is to investigate the effects of whole-body vibration
exposure on focus. This study was conducted to compare the effects in both
genders as well as individuals with ADHD. ·
The method used
to conduct this study was to use a focus game available through a brain
training app. The individuals participating in the study were either exposed
or not exposed to whole body vibration. This method was also used to
determine difficulty evaluations and comfort. |
·
Performance
in a focus game measured by the score at the end of each game. ·
The results
of the study determined that whole body vibration had a negative effect on
focus performance. ·
However,
three minutes into exposure, it proved to have positive effects on the test
subjects. Difficulty was not different based on gender, but females did
present an average of higher scores. |
[5] Impact
of COVID-19 on rehabilitation experiences of physiotherapists |
Physiotherapists who were practicing during the
COVID-19 pandemic. |
·
Physiotherapy
services during the COVID-19 pandemic (including both face-to-face practice
and telerehabilitation methods).
Control: Physiotherapists who
suspended their services due to the pandemic versus those who did not. ·
The main
purpose of this article is to determine the effects the COVID-19 pandemic had
on physiotherapists, the interruptions of their services during this time,
and the adaptations these professionals had to make in the services they
offered face-to-face. |
·
Number and
percentage of physiotherapists who suspended their services. ·
The method
used for this article was a descriptive, cross-sectional study of 558
physiotherapists that was completed through an online survey to collect and
evaluate data. ·
The results
of this study concluded that these professionals were interrupted during
their practices face-to-face, but continued to treat all patients, despite
any medical risk. |
[6] A
Qualitative Cultural Sensitivity Assessment of the Breathe Easier Mobile
Application for Lung Cancer Survivors and Their Families |
African American lung cancer survivors and their
families. |
·
Breathe
Easier mobile health application designed to teach strategies to combat
symptoms related to lung cancer. ·
Comparison: cultural sensitivity and relevance of the
Breathe Easier mobile app content compared to the specific needs and
preferences of African American lung cancer survivors and their families. ·
The main
purpose of this article is to evaluate the application Breathe Easier and its
effects on a specific population, African American lung cancer survivors and
their families. |
·
Culturally
relevant themes related to content literacy, inclusiveness, and acceptability
of the mobile application. ·
The methods
used in this study were cultural sensitivity tools and cultural sensitivity
checklists. In-depth interviews were performed on 12 survivors and their
family members. ·
The results
of this concluded with multiple benefits and concerns. Overall, these
subjects were more concerned with the information given via the application. |
[7] What
nursing interventions and healthcare practices facilitate type 1 diabetes
self-management in young adults? An integrative review |
Young adults aged 16-25 years with type 1
diabetes (T1D). |
·
Current
nursing and healthcare practices designed to facilitate effective T1D
self-management. ·
Traditional
nursing and healthcare practices that were not designed specifically for the
16-25 age group or not considering the advances in technology and social
platforms. ·
The purpose
of this article is to determine effective ways that current nursing and
healthcare practices can help facilitate self-management of type 1 diabetes
in individuals ages 16-25. |
·
Effectiveness
of digital information systems, glucose monitoring and insulin devices, group
and peer education and support, and diabetes care delivery style in improving
T1D self-management. ·
The method
used in this study was an integrative review that was performed to fully
understand what works and engages these patients with managing their type 1
diabetes. ·
The results
of this study conclude that there are 4 effective ways found that these
professionals could do to positively promote self-management in these
patients. |
[8] A Point-of-care app for chronic oedema management |
Health professionals using mobile devices for
patient care and patients/carers assuming greater control and responsibility
over their health, particularly those with chronic oedema and lymphoedema. |
·
se of the
mobile app "Juzo Care" designed for the management of chronic
oedema and lymphoedema in mobile working settings. ·
Comparison: traditional methods of managing chronic
oedema and lymphoedema without the use of mobile applications or
point-of-care technology. ·
The main
purpose of the article is to introduce a new app called the Juzo Care App, a
new Point-of-Care technology that has four main elements: the clinical
pathway, education, training, and information. |
·
Enhanced management
of chronic oedema and lymphoedema; patient empowerment to assume more control
and responsibility for their health; better support and education for
patients and their carers; improved and rapid clinical decision-making by
health professionals. ·
It was found
that the COVID-19 Pandemic changed the way we delivered healthcare in
American, sparking the idea for this app. ·
Mobile
devices like Juzo Care are an ideal tool for patients to use in today's
world. The Juzo Care app involves nurses, carers, and patients, in
identifying pathologies of lower-limb conditions related to the symptom of
oedema. ·
Although
there are other apps out there like Juzo Care, this one is different because
it supports health practitioners’ decision-making. |
[9] Development of an iPad-based assessment tool for
measuring attention and validation in older employees |
Elderly individuals aged between 65–85 years who
are working or may be potential candidates for working environments. |
·
The use of
the iPad-based attention assessment tool, "Shih-Hsu Test of
Attention" (SHTA). ·
The main
purpose of this article is to measure attention performance in the older
population still in the working field, to ensure that this generation is
still safe to use modern day technology. ·
The first
part of this study used an iPad-based attention assessment tool with auditory
stimuli, while the second part of the study examined the criterion related
validity. |
·
Criterion-related
validity and test-retest reliability of the SHTA to determine its efficacy
and reliability in assessing the work attention of the elderly. ·
No critical
evidence was found during this study and more research is needed to determine
if an older individual is in fact not safe to use a specific technology. |
[10] Experiences with Technology Amongst an International Sample of Older
Adults: Results from a Qualitative Interpretive Meta-Synthesis |
Older adults aging in the community, potentially
experiencing social exclusion or isolation. |
·
Training
older adults to use information and communications technology (ICT) to
mitigate social isolation impacts. ·
The main
purpose of this article is to show that information and communication
technology (ICT) use can assist in preventing the negative effects of
isolation amongst the elderly population and benefits of improving physical
and mental health. |
·
Three
overarching themes describing older adults' experiences with technology:
'desire for empowerment', 'connection', and 'aging well'. Also, an
understanding of the benefits of technology use among older adults aging in
Methods used were Qualitative
Interpretative Meta-Synthesis (QIMS) that utilized data from different
authors of publications on the subject merging their data together to develop
a more holistic understanding of the elderly use ICT. Some other authors
utilized focus groups, interviews (group and individual) and observations of
a diverse group of people across the world. ·
The finding
showed that older people's use of ICT improved community and social
engagement. Although using technology cannot replace face to face social
interaction, ICT since COVID has shown benefits in reaching the elderly
populations enhancing social connectivity, physical health, and psychological
wellbeing. Some limitations might occur with those that elderly people |
[11] Clinician Perspectives on Ethics and COVID-19: Minding the gap in
Sexual Reproductive Health |
Individuals in the U.S. seeking sexual and
reproductive health (SRH) services. |
·
Implementation
of policies and practices such as social distancing, sheltering in place,
shifting to telemedicine, and limiting care to essential procedures due to
COVID-19. ·
The purpose
of this article is to give a clinician's viewpoint on the disparities in
services and outcomes between marginalized and privileged populations and
offer suggestions for reducing these differences in the present and the
future. ·
Identifying
and tracking gaps will allow barriers to be addressed. In the end, it was
suggested that as COVID-19 lessens, decision makers/providers/advocates
should take inventory of the damages that covid caused and create ways to
restore services to better than they were. Expanding access through new
policies and programs (partnerships with communities). |
·
Wider gaps in
SRH outcomes and decreased access to SRH education, abortion, and contraceptives. ·
Observational/descriptive
study. The study design isn't explicitly mentioned but it's implied that the
article is describing observed effects based on enacted policies. |
[12] Harnessing Technology for the Social Good: Empowering Consumers with
Immediate Feedback and Self-Directed Means of Care to Address Affordability,
Access, and Stigma in Mental Health |
Individuals in the U.S. facing health
disparities, particularly in mental health care due to lack of access and
high costs. |
·
Use of
technology to provide affordable, easy access to mental health care,
including transformative technological tools and experiential medicine. ·
The purpose
of this article is to highlight how technology can create a means of
Increasing consumer participation and treatment effectiveness while providing
consumers with fast, inexpensive access to care. It is stated that
“technology alone is not enough to address these complex issues, but
harnessing technological innovation has implications that may prove
beneficial”. ·
This is
through tech tools creating greater flexibility in service delivery, as well
as improved self-regulation (patient accountability). |
·
Improved
mental health care access, increased consumer empowerment, affordability of
care, and increased treatment effectiveness. ·
It was found
that to create and test interventions that tackle the root causes of societal
problems, more research is required in transformational technology. |
[13] Women with Congenital Adrenal Hyperplasia: Promoting Cardiovascular
Health Across the Lifespan |
Women with Congenital Adrenal Hyperplasia (CAH). |
·
Targeted,
patient-centered, and interdisciplinary supports to mitigate and prevent
cardiometabolic risks associated with CAH. ·
This article
looks at promoting cardiovascular health across the lifespan, because Women
with CAH are more vulnerable to poor outcomes due to existing gender
disparities that impact cardiovascular disease outcomes and recognition. |
·
Improved
cardiovascular health, reduced cardiometabolic risks, better patient
outcomes, and enhanced health-related quality of life for women with CAH. ·
An
intervention mentioned for CAH/CVD care was health education/coaching
interventions that promote heart health across the lifespan to improve health
of women with CAH. |
[14] Using
mobile health applications to enhance physical activity in Saudi Arabia: a
cross-sectional study on users' perceptions. |
Users in Saudi Arabia who are >15 years of age
and use mobile health (mHealth) applications to promote physical activity. |
·
Use of mobile
health applications to promote physical activity. ·
Quantitative
cross-sectional study. |
·
Users'
perceptions on the usability and quality of mobile health applications,
including aspects like perceived usefulness, ease of use, attitudes, user
experience, and subjective quality. |
[15] Effectiveness
of a Smartphone App (MINISTOP 2.0) integrated in primary child health care to
promote healthy diet and physical activity behaviors and prevent obesity in preschool-aged
children: randomized controlled trial. |
Parents (n = 552) of 2.5-to-3-year-old children
recruited from 19 child health care centers across Sweden. |
·
6-month
mHealth intervention using the MINISTOP 2.0 app to promote healthy lifestyle
behaviors in children. The app was translated into English, Somali, and
Arabic. ·
Hybrid type 1
effectiveness-implementation design with a two-arm, individually randomized
controlled trial. |
·
Primary
Outcomes: Children's intake of fruits, vegetables, sweet and savory treats,
sweet drinks, moderate-to-vigorous physical activity, and screen time.
Secondary Outcomes: Parental self-efficacy (PSE) for promoting healthy
lifestyle behaviors and children's body mass index (BMI). |
[16] The
effects of a physical activity intervention based on a fatness and fitness
smartphone app for University students. |
100 Spanish university students (After applying
exclusion criteria: intervention group n = 35 and control group n = 31). Cluster-randomized trial. |
·
A 9-week physical
activity intervention designed to promote a healthy physical activity pattern
using a smartphone app. The mHealth approach contained five Behavior Change
Techniques (BCTs). ·
Control group
without the smartphone app intervention. |
·
Primary
Outcomes: Changes in physical fitness and self-reported physical fitness. ·
Secondary
Outcome: Changes in body fatness composition. |
[17] The
Effects of Adopting Mobile Health and Fitness Apps on Hospital Visits:
Quasi-Experimental Study. |
267,651 Chinese mobile phone users who provided
data on health and fitness app use and hospital-related geolocation from
January to December 2019.
Difference-in-differences and
difference-in-difference-in-differences design, with sensitivity analysis and
heterogeneity analyses. |
·
Adoption of
health and fitness apps. ·
Mobile phone
users before the adoption of health and fitness apps vs. after the adoption. |
·
Primary
Outcome: Decrease in hospital visits following the adoption of health and
fitness apps. ·
Other
outcomes: The varying effect based on users' socioeconomic status and digital
literacy. |
[18] Challenges
of Implementing an mHealth Application for Personalized Physical Activity
Counselling in Primary Health Care: A Qualitative Study |
Primary health care (PHC) providers participating
in the study.
A qualitative study using a descriptive
phenomenology approach with data collected through focus group discussions
(FGDs) and analyzed using a deductive thematic approach. |
·
Implementation
of the mHealth application (PAC app) for personalized PA counselling in PHC
settings. ·
Control:
primary health care settings without the use of the PAC app for PA
counselling. |
·
Primary
Outcome: Feasibility and challenges of implementing the PAC app in PHC
settings. ·
Secondary Outcomes:
Themes related to the use, barriers, patient involvement, and impact on PHC
services. |
[19] Predicting
Physical Exercise Adherence in Fitness Apps Using a Deep Learning Approach |
Users of the Mammoth Hunters Fitness app (n =
246).
A data analysis study employing pre-processing,
clustering, and regression modeling on user data to predict adherence. |
·
Automatic
classification of users into adherent and non-adherent based on their
training behavior in the first three months using an ensemble of regression
models. |
·
Primary
Outcome: Prediction of user training behavior (adherence) during the fourth
month. ·
Secondary
Outcomes: Accuracy and F1 score of the prediction model. |
[20] Profile
of adults users of smartphone applications for monitoring the level of
physical activity and associated factors: A cross-sectional study |
Asymptomatic Brazilian adults: 176 men and 178
women (43 ± 12 years; 27 ± 5 kg/m2).
Cross-sectional study design, involving
assessments and comparisons between APP users and non-users. |
·
Use of a
smartphone APP to monitor the physical activity level (PAL) that contains
functionalities such as exercise session logs and/or step counts. ·
Control: App users vs. non-users in terms of
demographic, socioeconomic, clinical, physiological, and functional
characteristics. |
·
Primary
Outcome: Profile of APP users in terms of demographic, socioeconomic,
clinical, physiological, and functional characteristics. ·
Secondary
Outcomes: Associations with variables like VO2 max, socioeconomic status,
quality of life, and others. |
[21] The
effects of a lifestyle intervention supported by the InterWalk smartphone app
on increasing physical activity among persons with type 2 diabetes:
Parallel-group, randomized trial |
Individuals with type 2 diabetes (T2D) referred
to municipality-based lifestyle programs.
Parallel-group, randomized trial with a 52 weeks’
intervention and a subsequent follow-up for effectiveness (52 weeks from
baseline). |
·
App-based (InterWalk)
approach in municipality-based rehabilitation which includes standard care +
InterWalk app–based interval walking training (IWT). Half of the IWT group
also received additional motivational support for up to 52-week follow-up. |
·
Primary
Outcome: Change in objectively measured MVPA time (minutes/day) from baseline
to 52-week follow-up. ·
Key Secondary
Outcomes: Changes in self-rated physical and mental HRQoL, physical fitness,
weight, and waist circumference. |
[22] Determinants
of fitness app usage and moderating impacts of education-, motivation-, and
gamification-related app features on physical activity intentions:
Cross-sectional survey study |
839 US residents who reported having used at
least one smartphone fitness app. |
·
Usage of smartphone
fitness apps with features related to education, motivation, and
gamification. ·
Control: non-users of smartphone fitness apps or
usage without specific features. |
·
User's
behavioral intention to use fitness apps. ·
Intentions of
being physically active. ·
Moderating
effects of different smartphone fitness app features and individual
differences on these intentions. |
[23] Commercial
app use linked with sustained physical activity in two Canadian provinces: A
12-month quasi-experimental study |
39,113 participants from two Canadian provinces.
12-month quasi-experimental study with a two-week
baseline period followed by a period where participants earned digital
incentives upon reaching their daily step goals.
Mixed-effects models were used to estimate
changes in physical activity levels based on engagement and baseline activity
status. |
·
Use of a
multi-component commercial app that rewards users with digital incentives
($0.04 CAD/day) for achieving a personalized daily step goal. ·
Control: physical activity levels during a two-week
baseline period prior to the introduction of digital incentives. |
·
Changes in
weekly mean daily step count between the baseline period and the last two
recorded weeks. ·
Step count increases
for various sub-groups based on engagement and baseline physical activity
status. |
[24] MINISTOP
2.0: a smartphone app integrated in primary child health care to promote
healthy diet and physical activity behaviours and prevent obesity in
preschool-aged children: protocol for a hybrid design
effectiveness-implementation study |
Families (n = 500) who attend routine visits to
one of the 15-20 primary child health care centres throughout Sweden when
their child is 2.5 years old. |
·
A 6-month parent-oriented
smartphone intervention aimed at improving the dietary and activity
behaviours of preschool-aged children using the MINISTOP 2.0 app. |
·
Primary
outcomes: Changes in dietary habits, physical activity, and screen time.
Secondary outcomes: Body weight and height changes in children, and parental
self-efficacy. ·
Implementation
outcomes: Perceived acceptability, appropriateness, and feasibility among
primary child health care nurses and parents. |
[25] User-centered
development of a smartphone application (Fit2Thrive) to promote physical
activity in breast cancer survivors |
Breast cancer survivors. Three independent groups
of participants: Group 1 (n=8), Group 2 (n=14), and Group 3 (n=15).
User-centered, iterative design process involving
field tests of the app across three groups of participants. |
·
Fit2Thrive,
an app designed to promote MVPA in breast cancer survivors. |
·
Usability and
quality of the app assessed by the Post-Study System Usability Questionnaire
(PSSUQ) and the User Version Mobile Application Rating Scale (uMARS).
Qualitative feedback on app functionality and content, including app
notifications. |
Table 2: Summary of Findings (n = 25).
Identification of Underlying Constructs
The review team identified four primary themes were identified in the literature, supporting the research topic of the use of mhealth applications as related to physical fitness during the search date range (Figure 2).
Figure 2: Primary occurrences of mhealth and physical fitness underlying themes (constructs) identified in the literature and related metadata. Discussion mHealth apps used to bring awareness of general health status
Upon systematic review, one common goal accompanying the introduction of mHealth apps was to bring more awareness of general health status to its users. mHealth apps helped bring awareness of a range of general health concerns, from common everyday health concerns to more commonplace diseases. This technology introduced aware-ness both through information and education. For example, mobile technology and mobile health interventions provided sexual education and provided information on sexual and reproductive health and was able to improve reproductive health outcomes and alleviate health disparities among minority populations [3,11].
MHealth technology also aided awareness in type I diabetes management, general patient care, social isolation, and cardiovascular health [7,8,10,13]. Not only did mHealth apps help with awareness in diseases and health concerns, but they also brought awareness of healthcare affordability and access [12]. Technology can be used to create a means of increasing consumer participation and treatment effectiveness while providing consumers with fast, inexpensive access to care. Finally, the apps were able to measure more personal features, including focus and attention span [4] amongst ADHD students and attention and validation amongst elderly working individuals [4,9]. Using mHealth apps as a way of measuring mental health and not just physical quantitative variables can help transform healthcare awareness and tracking in the future.
mHealth identifies ongoing effects of COVID-19 on physical fitness levels/status
During the COVID-19 pandemic, health and fitness was at an all-time low while many services and medical interventions were canceled. One type of intervention that was canceled during the COVID-19 pandemic was physiotherapy. One study conducted by Ciddi and Bayrum regarding this type of intervention, was to determine the status of physiotherapists who interrupted their services due to the pandemic and investigate procedures adopted by physiotherapists during face-to-face practice. Of the physiotherapists, 351 (62.9%) suspended their services due to pandemic, while 207 (37%) of all participants worked without suspending their services since the beginning of the process [5].
Another type of service that was affected by the COVID-19 pandemic was regarding the sexual and reproductive health of the population, along with the gaps in the services that were being provided. The study discusses the disparities in services and outcomes between marginalized and privileged populations, and also offers suggestions for reduc-ing these differences in the present and the future. The pandemic showed the current gaps within these services and how to improve them. It was suggested in the study that as the spreading of the pandemic declines, decision makers/providers/advocates should take inventory of the damages that were caused as well as create ways to improve services [11].
One of the largest benefits seen in healthcare from the COVID-19 pandemic was the new and innovative ways to use technology. Technology has become valuable and wide-spread, as well as supporting health care professionals in patient care. This technology also has the ability to educate patients, which will allow them more control over their care. This topic was researched to introduce a new app called the Juzo Care App, a new Point-ofCare technology that has four main elements: the clinical pathway, education, training, and information [8].
mHealth serving as a health education tool for personal improvement of physical fitness levels
A global shift in lifestyle continues, pushing many individuals to take measures for not only personal fitness, but continuance of physical distancing at times, or other related public health prevention measures since COVID-19. Traditional venues of physical activity like gyms, parks, and recreation centers were either temporarily closed or had restricted access. Within this backdrop, mHealth (mobile health) apps and platforms emerged as invaluable tools to educate and motivate individuals on maintaining and even enhancing their physical fitness [5, 23, 25]. The interactivity, accessibility, and flexibility of mHealth apps offered personalized workout regimens [9, 10], tracking features [1, 25], and informational resources that catered to varied fitness levels and needs [1, 5, 8, 11]. Users could access these tools anytime, anywhere, eliminating the barriers imposed by the pandemic.
In addition to providing exercise routines, mHealth platforms have delivered holistic health education, encompassing nutrition advice, sleep hygiene tips, and mental well-being resources [15, 20]. This comprehensive approach encouraged users to under-stand the intricate relationship between different aspects of health, allowing for an informed and well-rounded personal improvement journey. As the pandemic heightened stress and uncertainty, the mental health components, combined with physical fitness guidance, played a crucial role in assisting individuals in staying resilient [15, 20, 24]. The widespread adoption and reliance on mHealth apps during the COVID-19 era underscore their potential not only as fitness aids but as holistic health educators and motivators for personal growth.
Finally, it is important to also note the ongoing/additional research from other countries focusing on mHealth applications and related developments to further individual health. The COVID-19 pandemic has highlighted the importance of the virtual world in providing solutions to everyday challenges, leading to increased reliance on modern technology for communication across all sectors of society [26]. In particular, one study assesses the impact of such technologies on individual personalities, utilizing textual analysis to explore both the benefits and drawbacks of this shift towards virtual interaction. Concluding that technological devices offer significant advantages for personal development, their integration into our lives also poses potential risks to personal and family relationships, such research underscores the need for a balanced approach to their use [26]. Additionally, future research may even involve furthering a study which explores the relationship between social evaluation and personal well-being [27]. Concluding that personal well-being is significantly influenced by social acceptance and self-acceptance, diminishing psychological health as related to physical health and the use of mHealth applications will require continued assessment for outcomes, both physically and psychologically [27].
Conclusion
This systematic literature review on mHealth since 2022 and the global pandemic has unveiled several salient themes and underscored the transformative potential of mobile health solutions in the face of global health crises. Notably, mHealth applications have demonstrated a unique aptitude for enhancing accessibility to health information, facilitating remote patient monitoring, and fostering patient engagement, while also serving as vital conduits for disseminating public health advisories and gathering epidemiological data. Another emergent theme is the adaptive nature of mHealth platforms, which have evolved rapidly in response to the dynamic needs presented by the pandemic, from contact tracing capabilities to mental health support modules.
As a transition to a post-pandemic world continues, there is a pressing need to further scrutinize the long-term viability, scalability, and ethical implications of mHealth tools. Future research should investigate the sustainability of behavioral changes instigated by mHealth interventions and evaluate their impact in real-world, non-pandemic settings. Moreover, it would be instructive to explore how mHealth can be integrated more seamlessly into traditional healthcare infrastructures and the potential for these tools to foster global health collaboration, transcending geographical and institutional boundaries. As the dust settles on the pandemic, the lessons derived from this review should guide the next wave of mHealth innovations, ensuring they are more inclusive, effective, and responsive to the multifaceted needs of global populations.
Author Contributions: All authors contributed to this review in accordance with ICMJE standards. C.L., E.C., M.V., D.S., D.T., C.W., and A.W. contributed to investigation into the research topic, participation in the method, and drafting of the manuscript. In addition to screening and assistance with construct identification, E.C. also assisted with discussion/analysis and overall editing of the manuscript. All authors have read and agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Conflicts of Interest: The authors declare no conflicts of interest.
References
- Chandrasekaran B, Rao CR, Davis F, Arumugam A (2021) SMART STEP – SMARTphone-driven exercise and pedometer-based STEP intervention to promote physical activity among desk-based employees: Study protocol for a three-arm cluster randomized controlled trial. Work 69:1229-1245.
- Cimarras-Otal C, Marcen-Cinca N, Rabal-Pelay J, Lacrcel-Tejero B, Alczar-Crevilln A, et al. (2020) Adapted exercises versus general exercise recommendations on chronic low back pain in industrial workers: A randomized control pilot study. Work 67:733-740.
- Chandler R, Guillaume D, Parker AG, Carter S, Hernandez ND (2020) Promoting Optimal Sexual and Repro-ductive Health with Mobile Health Tools for Black Women: Combining Technology, Culture and Context. Perspectives on Sexual & Reproductive Health 52: 205–209.
- Duarte MLM, Costal GZ, Martinelli SF, Neves JLB (2020) Effects of vehicular whole-body vibration on focus measured by a mobile app for brain training: A pilot study on the influence of gender and Attention Deficit Hyperactivity Disorder. Work 67: 641–654.
- Ciddi PK, Bayram GA (2022) Impact of COVID-19 on rehabilitation experiences of physiotherapists. Work 71: 31–39.
- Owens OL, Smith KN, Beer JM, Gallerani DG, McDonnell KK (2020) A Qualitative Cultural Sensitivity Assessment of the Breathe Easier Mobile Application for Lung Cancer Survivors and Their Families. Oncology Nursing Forum 47: 331–341.
- Phiri T, Mowat R, Cook CM (2022) What nursing interventions and healthcare practices facilitate type 1 diabetes self-management in young adults? An integrative review. Nursing Praxis in Aotearoa New Zealand 38: 32–43.
- Collett M (2020) A point-of-care app for chronic oedema management. Br J Community Nurs 25:S12-S16.
- Shih YN, Hsu JL, Wu CC, Hsiao JH (2020) Development of an iPadbased assessment tool for measuring at-tention and validation in older employees. Work 67: 811–815.
- Miller V, Murphy ER, Fields N, Cronley C (2021) Experiences with Technology Amongst an International Sample of Older Adults: Results from a Qualitative Interpretive Meta-Synthesis. British Journal of Social Work 51:1332–1353.
- Ott MA, Bernard C, Wilkinson TA, Edmonds BT (2020) Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health. Perspectives on Sexual & Reproductive Health 52:145–149
- Ross M (2020) Harnessing Technology for the Social Good: Empowering Consumers with Immediate Feedback and Self-Directed Means of Care to Address Affordability, Access, and Stigma in Mental Health. Health Soc Work 45:135–137.
- Davina B, Joanne H, NinaC, Shayna D, Nicole T, et al. (2020) Women with congenital Adrenal Hyperplasia: Promoting cardiovascular Health Across the lifespan. Canadian Journal of Cardiovascular Nursing 30:4–9.
- Ansari FSA, Alfayez A, Alsalman D, Alanezi F, AlhodaibH, et al. (2023) Using mobile health applications to enhance physical activity in Saudi Arabia: a cross-sectional study on users’ perceptions. Int Health 15:47-55.
- Alexandrou C, Henriksson H, Henström M, Henriksson P, Nyström CD, et al. (2023) Effectiveness of a Smartphone App (MINISTOP 2.0) integrated in primary child health care to promote healthy diet and physical activity behaviors and prevent obesity in preschool-aged children: randomized con-trolled trial. Int J Behav Nutr Phys Act 20:22.
- Muntaner-Mas A, Sanchez-Azanza VA, Ortega FB, Vidal-Conti J, Borràs PA, et al. (2021) The effects of a physical activity intervention based on a fatness and fitness smartphone app for University students. Health Informatics Journal 27:1–14.
- Bo y, Liu QB, Tong y (2023) The Effects of Adopting Mobile Health and Fitness Apps on Hospital Visits: Qua-si-Experimental Study. J Med Internet Res 25:e45681.
- Wattanapisit A, Amaek W, Wattanapisit ST, Tuangratananon T, Wongsiri S, et al. (2021) Challenges of Implementing an mHealth Application for Personalized Physical Activity Counselling in Primary Health Care: A Qual-itative Study. International Journal of General Medicine 14:3821-3831.
- Jossa-Bastidas O, Zahia S, Fuente-Vidal A, Férez NS, Noguera OR, et al. (2021) Predicting Physical Exercise Adherence in Fitness Apps Using a Deep Learning Approach. Int J Environ Res Public Health 18:10769.
- Vieira WDO, Ostolin TLVDP, Simões MDSMP, Proença NL, Dourado VZ (2022) Profile of adults users of smartphone applications for monitoring the level of physical activity and associated factors: A cross-sectional study. Front Public Health 10:966470.
- Yang IK, Valentiner Y, Glümer LS, Karstoft C, Brønd K, et al. (2022) The effects of a lifestyle intervention supported by the InterWalk smartphone app on increasing physical activity among persons with type 2 diabetes: Paral-lel-group, randomized trial. JMIR MHealth and UHealth 10:1–18.
- Yang Y, Koenigstorfer J (2021) Determinants of fitness app usage and moderating impacts of education-,motivation-, and gamificationrelated app features on physical activity intentions: Cross-sectional survey study. J Med Internet Res 23:e26063.
- Mitchell M, Lau E, White L, Faulkner G (2020) Commercial app use linked with sustained physical activity in two Canadian provinces: A 12-month quasi-experimental study. Int J Behav Nutr Phys Act 17:24.
- Henriksson H, Alexandrou C, Henriksson P, Henström M, Bendtsen M, et al. (2020) MINISTOP 2.0: a smartphone app integrated in primary child health care to promote healthy diet and physical activity behaviours and prevent obesity in preschool-aged children: protocol for a hybrid design effective-ness-implementation study. BMC Public Health 20:1756.
- Welch WA, Solk P, Auster-Gussman L, Gavin KL, Whitaker M, et al. (2022) User-centered development of a smartphone application (Fit2Thrive) to promote physical activity in breast cancer survivors. Transl Behav Med 12:203-213.
- Budayová Z, Pavliková M, Al-Adwan AS, Klasnja K (2022) The Impact of Modern Technologies on Life in a Pandemic Situation. Journal of Education Culture & Society 13:213–224.
- Danylchenko T (2021) Correlation between the Individual’s Experience of Well-Being and Social Evaluation. Journal of Education Culture & Society 12:179–189.